title: Dose adjustment guidelines for medications in patients with renal impairment: how consistent are drug information sources?
abstract: BACKGROUND
  It is known that patients with renal disease are often administered inappropriate dosages of drugs. A lack of quantitative data in the available drug information sources and inconsistency in dosing information may augment the problem of dosing error.
  
  
  OBJECTIVE
  To determine the concordance among five drug information sources regarding the dosing recommendations provided for drugs considered problematic in patients with renal impairment and to determine the consistency among the sources regarding the definition of renal impairment and categorisation of chronic kidney disease.
  
  
  METHODS
  Five standard drug information sources were reviewed for 61 drugs recommended to be used with caution in renal impairment. Information on recommendations for dosage adjustment in renal impairment was extracted and analysed. Further, the definition and classification of renal impairment were recorded. The recommendation for each drug was coded into six different categories and the intersource reliability was calculated.
  
  
  RESULTS
  Only slight agreement was observed among the sources (Fleiss Kappa: 0.3). Qualitative data were not well defined, and there was a lack of consistency in quantitative values. Some drugs marked as contraindicated in one source were not mentioned as such in others. Also, drugs considered as not requiring dosage adjustment in one source had explicit recommendations in other sources. The definition and classification of renal impairment differed among the five information sources.
  
  
  CONCLUSIONS
  There should be an evidence-based approach to drug dosage adjustment in order to bring uniformity to the recommendations. Regular updating of the content of the drug information sources is also important.
authors.affiliation: School of Pharmacy, University of Tasmania, Hobart, Tasmania, Australia.
authors.forename: A
authors.initials: A
authors.lastname: Khanal
authors.forename: R L
authors.initials: RL
authors.lastname: Castelino
authors.forename: G M
authors.initials: GM
authors.lastname: Peterson
authors.forename: M D
authors.initials: MD
authors.lastname: Jose
mesh_terms: D000075202:Contraindications; D054796:Drug Dosage Calculations; D004346:Drug Information Services; D064420:Drug-Related Side Effects and Adverse Reactions / Q000517:prevention & control; D006801:Humans; D004364:Pharmaceutical Preparations / Q000008:administration & dosage*; D010599:Pharmacokinetics; D017410:Practice Guidelines as Topic; D051436:Renal Insufficiency, Chronic / Q000378:metabolism*; D015203:Reproducibility of Results
chemical_list: D004364:Pharmaceutical Preparations
keywords: dosage adjustment; drug prescribing; guideline; kidney disease; renal impairment